Bill toughens vaccine opt out option; Proposed law could make obtaining immunization exemptions harder for parents

Public health officials are looking to a proposed bill that would amend the California Health and Safety Code to help reduce the number of Humboldt County parents who opt out of some or all immunizations for their kindergartners.

AB 2109, sent to Gov. Jerry Brown's desk last Thursday, would require parents to speak with their health care practitioners about the risks and benefits of immunizations before obtaining a personal belief exemption for their children.

California is one of 20 states that currently allows children to be exempted from required immunizations if their parents obtain a personal belief exemption.

Based on a California Department of Public Health report, countywide about 23 percent of kindergartners who entered school in 2011 had not been fully immunized. Of those, about 10 percent opted out of required immunizations by filing personal belief exemptions.

Of the 62 schools surveyed in Humboldt County, the state reported that three charter schools -- Alder Grove in Eureka (73 percent), Coastal Grove in Arcata (65 percent) and Union Street in Arcata (53 percent) -- had the highest rates of personal belief exemptions.

Susan Buckley, the Humboldt County Department of Health and Human Services' Public Health director, said the exemptions contribute to low vaccination rates, which put all students at risk.

"We want to help parents make the choice to immunize," she said. "We think AB 2109 could help educate parents to do that."

The proposed amendment would require that parents obtain a signature from their health practitioner on a form saying they had discussed the benefits and risks of immunization and the health risks of specified communicable diseases.

Buckley said one of the many reasons that parents opt out of immunizations is the belief that their children may develop autism from the vaccines. Still others worry that their children can contract the disease from the vaccine designed to prevent it.

"We are concerned that a lot of parents have erroneous information about the risks and not enough information about the benefits of vaccines," she said.

At Alder Grove Charter School -- where, according to the state, 73 percent of last year's kindergartners were opted out of vaccinations -- Director Jenni Giovanni said she suspected the non-traditional nature of the school, which includes a homeschool program, might be one of the reasons. She said the numbers will likely be different for this year's class.

"They change every year," she said. "Right now, we are adding up the numbers for next year and they look much lower."

Regardless of why parents choose not to vaccinate their children, public health officials say the result is the same: an increased risk of a communicable disease outbreak.

Buckley pointed to a 2009 outbreak of whooping cough that infected 14 children in Southern Humboldt. She said the outbreak corresponded with an increase in personal belief exemptions obtained by parents in the area.

"We were really happy to see the personal belief exemption rate drop off after that incident," she said. "I have to believe the impact of young children being very sick helped parents rethink their decision to skip immunizations."

One of the primary concerns with personal belief exemptions, Buckley said, is that it contributes to vaccination rates being too low to provide community immunity, or herd immunity, the threshold at which -- if a person contracts a disease -- the odds of running into an unimmunized individual are minimal.

With community immunity, the case would basically stop with only one child getting sick. When vaccination rates are low, especially in classrooms where diseases can travel quickly from child to child, that doesn't happen.

Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control, said some parents don't realize that vaccines do not provide complete protection.

"Most vaccines are not 100 percent effective," she said. "People can still become infected, even if they have been vaccinated, if they are around someone who is not immunized and has the disease."

Wharton said higher vaccination rates -- ideally above 90 percent -- reduce the odds of that happening. Community immunity also helps protect the small number of individuals who cannot receive vaccines for medical reasons.

"Some people have a several allergy to a particular vaccine, or are being treated for leukemia or cancer," she said. "The higher the coverage, the more protection these individuals have."

Although the Centers for Disease Control does not typically weigh in on state legislation, Wharton said from a personal standpoint she thought AB 2109 sounded like it could be a good thing for parents.

"In general, it seems reasonable to me that parents should have full, complete and accurate information on which to make decisions regarding their children's health," she said.